1. Field of the Invention
The present application relates to, inter alia, systems and methods for Emergency Department coding.
2. Background Discussion
Emergency departments perform numerous medical treatments and procedures. In contrast to other types of medical facilities, emergency departments tend to handle a very wide range of medical issues—i.e., from head colds and viruses, to seeing of patients of other doctors when regular doctor's offices are closed (i.e., thousands of doctors offices even have voicemail messages directing patients to emergency departments after hours when timely treatment is required), to addressing physical injuries related to accidents and/or traumas, etc. As such, emergency departments need to document an extremely wide range of treatments, procedures and diagnoses. In particular, in order to properly a) bill patients and b) have insurance companies reimburse for such billing to patients, it is important that such treatments and diagnoses are properly recorded. However, due to the vast range of treatments, procedures, and diagnoses handled by Emergency Departments, this has proven to be a very difficult task for Emergency Departments.
Moreover, to compound this already vexing problem, Emergency Departments face other difficulties not experienced by most other medical facilities: a) patients frequently arrive without any pre-established appointment scheduled, such that it is frequently more difficult to accommodate fluctuations in workload (including handling of paperwork related to billing) for patients); b) patients often have time-sensitive emergencies requiring immediate treatment and care, such that it is frequently more difficult to process paperwork related to billing, etc., more expeditiously; and c) Emergency Departments often handle much greater volumes of patient visits than other medical facilities.
As a result, Emergency Departments often have difficulty to properly document patient visits and treatment in a manner to ensure that insurance carriers will reimburse the facility for their services and treatment. In situations where services and treatments are not properly documented (i.e., including the incorporation of proper medical “Codes” indefinable by insurance carriers), then the Emergency Department may not be compensated for that expense. As such, Emergency Departments can lose millions of dollars annually due to such difficulties.
Prior to the present invention, Emergency Departments have hired experienced individuals as “Coders” to have such individuals review all documentation prepared by the ED physicians and staff to ensure that the documents can be used to create proper bills for patients, which bills are appropriate in light of various insurance carrier rules and guidelines to ensure as much reimbursement as possible. Coders can, thus, often perform tasks such as review of medical record documentation for proper diagnosis and procedure code selections to provide billing, coding and auditing support to medical facilities for both inpatient and outpatient facility and professional billing functions.
Even though professional Coders are typically employed, there can still be many difficulties in the proper coding and obtaining of reimbursements from, e.g., insurance companies related to such treatments and procedures. Coding in Emergency Departments is rather involved, and individuals that perform such coding often require certification to become coders. In addition, there are even certain companies that have been established to provide coding expertise and assistance to Emergency Departments, such as, e.g., Medical Reimbursement Systems, Inc. (MRSI), the present assignee, which provides emergency physician coding and related billing and follow up for both physicians and facilities. Such coding includes, e.g., both local and national emergency medicine coding and reimbursement issues.
However, prior to the present invention, which greatly facilitates coding capabilities and greatly improves quality and accuracy, coding has been a very complicated function and operation.